Cancer Care Close to Home

Traffic is a hassle under the best of times, but if you are battling cancer or helping someone who is, every unnecessary logistical complexity is yet one more exhausting hurdle to recovery and health.

Recognizing the value of conveniently located expertise, UC San Diego Health System is expanding its services in North County and South Bay to bring the best of academic medicine to communities throughout the greater San Diego region through collaborations with local doctors and health care professionals.

In North County, this shift to community-based, academic-level specialized care is evident in the options available for women with breast cancer which, though terrifying, is often highly curable and even preventable.

“Many women have a lot of fear about breast cancer, but their prognosis is very good in many cases,” said Rupa Subramanian, MD, a breast cancer oncologist with UC San Diego Health System who sees patients in the new Encinitas and Vista locations. “What we are doing is bringing the academic health care experience to the North County community. We are coming to patients. That is very important.”

“Most of my patients are diagnosed by doctors at other hospitals,” she said. “They may have their surgeries at local hospitals. Our model is to work with community doctors and include them on our tumor boards with tertiary-care specialists.”

A tumor board refers to a roundtable of medical specialists (oncologists, statisticians, endocrinologists, radiologists and cancer surgeons, for example) who are brought together to review a patient’s history, treatment and progress.

By drawing on each other’s fields of expertise, the group charts a course of care for a patient that incorporates a greater depth of knowledge than would be possible otherwise.

The team is also able to take advantage of highly specialized medicine, experimental therapies and advanced diagnostics available at UC San Diego Moores Cancer Center, one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers in the country and the only one in San Diego County.

“We have a comprehensive cancer treatment center in North County, right here in their backyard,” said Derek Helton, MD, FACP, medical director for the Encinitas and Vista offices of the UC San Diego Health System. “Our patients have access to state of the art multidisciplinary cancer care in a supportive and hopeful environment.”

“We work hard to help each patient and their families navigate what can be an otherwise overwhelming time in their lives,” he said. “This helps us focus on achieving goals of care that can be tailored to the individual."

Sara Andolina, a Vista resident, can attest to the lifesaving convenience of having academic medicine in the community.

“It was a perfect storm when I discovered I had breast cancer,” Andolina said. “I was in school. My dad had just been in critical care. My sister had just had a baby. It was Christmas time. I didn’t want the holidays to be all about my breast.”

She also feared the “C-word” because her mother, maternal grandmother and maternal aunt had all died of breast cancer. Andolina’s cancer had already spread to her lymph nodes.

Given her diagnosis and family history, Andolina decided to have a double mastectomy. During the surgery, it was discovered she also had thyroid cancer, separate from breast cancer.

An endocrinologist was added to her tumor board.

“I got to know the doctors at the cancer clinic pretty well,” Andolina said. “You get catapulted into this cancer world and it becomes your whole world.”

A molecular characterization of tissue from her breast tumor showed she had an aggressive form of cancer, known as HER2 positive. This meant her cancer tested positive for the HER2 gene, which promotes cell growth and in the past has made the cancer more aggressive and deadly.

“My mother was HER2 positive,” Andolina said. “They knew what it was back then, but there were not the treatments available yet.”

The standard treatment for HER2 positive breast cancer today includes a targeted therapy known as trastuzumab, or Herceptin. Herceptin does not produce the nauseating side effects of chemotherapy, but it must be administered weekly. Andolina was able to receive her treatment in the North County offices, which also provide radiation and chemotherapies.

“I would have driven wherever I needed to go to get the treatment I needed, but it was very convenient to get all my care in North County,” Andolina said. “I was at the cancer clinic quite a lot. I always knew I was in good hands. I never felt rushed.”

Yet another benefit of the North County clinics are their proximities to free acupuncture, massage, yoga, nutrition and cancer support groups offered through the non-profit San Diego Cancer Research Institute.

“A lot of my patients are very interested in holistic, integrated medical care,” Subramanian said. “They want to know what they can do to keep the cancer from coming back and how to prevent it in their daughters. That is an important part of our practice.”